Are We Secretly Our Own Worst Enemies?

If you’ve been reading South African news, you’ll know that at least 300 interns and community service doctors stand to be unemployed next year, due to a lack of funded posts at accredited institutions.

Perhaps you read about our inhumane working hours last year.

Perhaps you have read about the overflowing hospitals where patients pile up in the corridors.

These are not new problems, we just hear about them more because doctors and patients have phones with cameras, and social media accounts.

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When I was ill recently (appendicitis) there was a shift of mine that nobody could cover. The hospital should have paid a locum to do it. Instead, people cancelled their plans and shifted around and, with great cost to themselves, made it work.

South African doctors are really good at “making it work”. Maybe that’s why we’re so well-loved in other countries. In a natural disaster, South African doctors will be the ones who work day and night among the injured and ill. They’ll find sleeping space for the destitute, but not for themselves. They’ll jerry rig drip stands. They’ll crack open chests with minimal tools. They’ve seen horror in their own practice, and they won’t be overwhelmed by this horror. Or at the very least, they won’t show it.

We “make it work” every day in state hospitals. And our employers know that we will make it work, and maybe that is why nothing changes.

Our nurses – bless them – have indomitable unions. When they speak, the administration listens, lest they suffer the wrath of a union inciting its members to protest. And they get results.

At my hospital, nursing staff have two 30-minute tea breaks as well as an hour lunch break during their twelve-hour shift. The doctors have no guaranteed break(s). I have eaten my lunch at 01h00 in the morning. I have arrived home after a 26 hour shift and realised that I did not pee my entire shift (and then I wonder why I have a post-call headache).

I have worn surgical gloves two sizes too big because my size had not been in stock at a certain hospital for over two years. I learned how to adjust my technique to avoid slipping. I still ended up with a needle stick injury that year.

I know of people who have worked shifts while hooked up to an IV line, because they knew that their patients would not be seen otherwise.

When we are short-staffed, we make it work. We cut team sizes to the minimum so that everything is covered. We come to work earlier, and finish later. We skip teaching meetings and training and courses because patients are dying, and further education is really a just a privilege, right?

But…

We

Never

Drop

The

Ball.

And maybe that’s the problem.

We stretch our muscles to breaking point to catch all those balls. We become weary and strained, but we hold on.

Maybe if we dropped some of those balls – dropped them so they clattered across the floors, and people stepped on them and tripped over them and they became a real nuisance – maybe then something would change.

Because we say that we are overworked, but all our employers see is patients who are saved at the witching hour.

We say that we are short-staffed, but all they see is that the shifts are covered and the work is done.

We say that we are under-resourced, but then we find private funders for our new ICUs, and to paint our hospitals, and to provide the medication our government will not provide.

Where is the impetus for change? It is not there, because we make it work.

Perhaps we are too proud to let the ball drop. We’re too proud to say, we can’t: we need help. Because isn’t that how we got ourselves through medical school in the first place – by convincing ourselves that we were invincible?

dbf8e6f859df16669b4d3d302c86a486There is a story about an oncology department at a KwaZulu-Natal hospital that had its medical officer program shut down. The remaining doctors left, because they could not run a service without medical officers. Very quickly, the Department of Health funded the MO posts, and the service was up and running again.

Sometimes I think that may be the only way we ever achieve anything.

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The Threat of Funemployment

In final year, we thought that getting an internship post at our desired hospital was the hardest – and most coveted – thing.

Two years later, we all tried to find a community service posting that would give us a foot into the door to our future specialties.

But we didn’t know that those were the easy parts. Then, we still pretty much had guaranteed employment (most of us, at least).

Then came the end of Community Service, and reality hit us in the face: we were on our own.

* * *

That’s where I am now. The government no longer “owes” me a job, and unless I find one, I’ll be unemployed come January 2018. People used to say, “There’s no such thing as an unemployed doctor.” These days, there are plenty of them, because freezing posts is a done thing.

Applying for my first post-comserve job is a bit like the whole “what do I want to do when I grow up” crisis all over again. Because I want to work with children, but how many paediatrics posts are available? Not many. And paeds has seen an upsurge in popularity, so the available posts are highly sought-after.

So what other jobs would I like to do? Jobs that could teach me something before I go back to working with children. But if something happens and I end up stuck in that job for a long time, will I be okay with it?

Looking for a job is an exercise in self-reproach. Why didn’t I do more courses this year? Why didn’t I write that diploma? Why didn’t I participate in more research? Why didn’t I suck up a little more, make sure people knew my name? Look at what everyone else has achieved. Why haven’t I?

It’s an opportunity to be kind to myself. I’ve had a big year.

I started therapy and finally found the right combination of meds.

I ended a long-term relationship.

I stayed on my own for the first time. The past few years were just adulting-lite. This year I had to learn the real art of adulting.

I finally started making friends.

As I explored this new city, I also explored myself.

I found parts that I hate. I found parts that I love.

I stepped out of my comfort zone, and as usual, it was rewarding.

Finding a post-comserve job is probably the scariest part of my medical career so far. I know I must not compare myself to others, but I also know that an interview panel will do exactly that. (By the way, I screwed up my most important interview. I got total stage-fright.)

This is also a time of great promise. It reminds me of everything I can do with this degree. It reminds me that I can stretch my wings. It reminds me that I am not captive. I am free.

 * * *

Sorry if you came here looking for some inspiration. I had to type because my nails were already bitten to the quick. Find me a job, and maybe I’ll be able to get back to the usual stuff.

DOC-U-MENTALLY: The Film [Review]

Breaking this unintentional hiatus to tell you (read: shout from the rooftops) that I have watched Doc-u-mentally and

IT.

IS.

AMAZING!

Continue reading “DOC-U-MENTALLY: The Film [Review]”

Working in the Land of Milk and Honey

I recently realised that some of my posts have disappeared into thin air. I’m not sure how, but I’m reposting them courtesy of the web archive.

By some kind of dumb luck, I am doing my Community Service posting at an incredible children’s hospital in Cape Town, rather than the archetypal middle-of-nowhere clinic post we all expect for ComServe.

And it’s incredible.

This hospital is just something else. It’s public, but has so much private funding that it might as well be a private hospital. It gets a lot of private patients so clearly I’m not alone in my perception.

Some things that continue to blow my mind: Continue reading “Working in the Land of Milk and Honey”